MACKENZIE MASTIN – Physical Therapist, NPI 1154090637

MACKENZIE MASTIN is a healthcare provider. based in Bolingbrook, Illinois. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. The NPI Number for MACKENZIE MASTIN is 1154090637

Main info

Female
5 Years Of Experience
Accepts Medicare Assignment
Name
MACKENZIE MASTIN
NPI
1154090637
Phone
Not provided
Address
790 REMINGTON BLVD
Enumeration Date
8 September 2021
Last Update Date
8 September 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7062265533
Graduation Year
2021 (5 years ago)
PAC ID
3779981220
Group Practice PAC ID
4284624446
Professional Enrollment ID
I20211025002543
Address ID
GA307208442DA1300XWAYX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:4State licenses:0Digital endpointsOther names

2,334 PHYSICAL THERAPIST IN PRIVATE PRACTICE in TN

Provider Addresses for MACKENZIE MASTIN

  • 790 REMINGTON BLVD

    BOLINGBROOK, IL 604404909

    Phone:

    Type: Mailing

  • 2125 NORTHPOINT BLVD

    HIXSON, TN 373434072

    Phone: (423) 875-3376

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2021-10-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20211013002530IPhysical Therapist In Private PracticeTNTBD
I20211025002543IPhysical Therapist In Private PracticeGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes2,188141$0
97161Evaluation for physical therapy, typically 20 minutes122118$0
97035Application of ultrasound, each 15 minutes4117$0
View full utilization report →

Insurance plans in this area (ZIP 60440)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4284624446View full group profile
NameSpecialtyState
Orthopedic SurgeryGA
Physical Therapist In Private PracticeGA
-GA
Physician AssistantGA
Orthopedic SurgeryGA
Physician AssistantGA
Nurse PractitionerGA
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeGA
Physician AssistantGA

Reviews

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Frequently asked questions

Does MACKENZIE MASTIN share an NPI with anyone else?
NPI numbers are unique to each provider or organization — MACKENZIE MASTIN uses 1154090637.
Does the file indicate MACKENZIE MASTIN is practicing under active NPI?
Directory data currently reports MACKENZIE MASTIN as active.
What taxonomy line describes MACKENZIE MASTIN?
For research purposes, treat MACKENZIE MASTIN as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
Does MACKENZIE MASTIN list a practice location?
Patients near Bolingbrook, Illinois may find MACKENZIE MASTIN in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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